Category Archives: Antibitoc Resistance

The use of antibiotics among Americans with commercial health insurance has decreased during the past several years, according to a new analysis that nevertheless
shows lingering variations for different ages and in different parts of the country.

The study released provides the latest evidence of how doctors and patients have begun to heed warnings that excessive antibiotic use breeds dangerous drug resistance and “superbug” bacteria.

The analysis is based on 173 million insurance claims from people under age 65 with Blue Cross Blue Shield coverage
who filled prescriptions
between 2010 and 2016.

It is a sequel of sorts to research by the federal Centers for Disease Control and Prevention, which found a smaller decline and comparable age and geographic variations.

The CDC reported a 5 percent decrease overall between 2011 and 2014 in antibiotic prescriptions written in outpatient settings such as doctors’ offices, clinics and hospital emergency rooms.

The study by the Blue Cross Blue Shield Association found that 9 percent fewer antibiotics prescribed in outpatient settings were filled in 2016, compared with 2010.

Vancomycin, long considered a “drug of last resort,” kills by preventing bacteria from building cell walls. It binds to wall-building protein fragments called peptides, in particular those that end with two copies of the amino acid D-alanine (D-ala). But bacteria have evolved. Many now replace one D-ala with D-lactic acid (D-lac), sharply reducing vancomycin’s ability to bind to its target.

The world’s last line of defense against disease-causing bacteria just got a new warrior: vancomycin 3.0. Its predecessor—vancomycin 1.0—has been used since 1958 to combat dangerous infections like methicillin-resistant Staphylococcus aureus.

But as the rise of resistant bacteria has blunted its effectiveness, scientists have engineered more potent versions of the drug—vancomycin 2.0.

Now, version 3.0 has a unique three-pronged approach to killing bacteria that could give doctors a powerful new weapon against drug-resistant bacteria and help researchers engineer more durable antibiotics.

“This is pretty special,” says Scott Miller, a chemist at Yale University who was not involved in the new work. “It’s really the culmination of a decades-long effort.”

Vancomycin, long considered a “drug of last resort,” kills by preventing bacteria from building cell walls. It binds to wall-building protein fragments called peptides, in particular those that end with two copies of the amino acid D-alanine (D-ala). But bacteria have evolved. Many now replace one D-ala with D-lactic acid (D-lac), sharply reducing vancomycin’s ability to bind to its target.

Today, that resistance has spread so that dangerous infections like vancomycin-resistant enterococci (VRE) and vancomycin-resistant Staphylococcus aureus (VRSA) are becoming more common. According to the U.S. Centers for Disease Control and Prevention, about 23,000 Americans die from 17 antibiotic-resistant infections each year (although it’s difficult to parse out how much is due to vancomycin resistance).

To solve the D-lac problem, researchers led by Dale Boger, a chemist at the Scripps Research Institute in San Diego, California, began synthesizing new versions of vancomycin that bind to peptides ending in D-ala and D-lac.

They succeeded in 2011. Meanwhile, other groups developed new ways of killing bacteria with vancomycin: One alteration found a novel way to halt cell wall construction, whereas another caused the outer wall membrane to leak, leading to cell death.

Moreover, when Boger’s team tested vancomycin-resistant bacteria against the new three-part analog, the microbes were unable to evolve resistance even after 50 rounds.

Many antibiotics begin to fail after just a few rounds.

This suggests the new compound may be far more durable than current antibiotics, Boger says.

“Organisms just can’t simultaneously work to find a way around three independent mechanisms of action,” he says. “Even if they found a solution to one of those, the organisms would still be killed by the other two.”

Miller adds that antibiotics are often found by trial and error when researchers test a new compound to see whether it stops bacterial growth. By contrast, this work shows the power of rationally designing novel antibiotics to hit microbes where they are weak. “Getting something to do two things by design is hard. Getting something to do three things by design is even harder.”

Still, Boger cautions that the new compound isn’t yet ready for human trials. Next up, he and his colleagues plan to cut down on the 30 chemical steps it takes to make the new compound, in the hopes of producing it more cheaply.

Then they’ll test their drug in animals, and finally humans. If it passes this gauntlet, humanity’s last line of defense against dangerous infections will become considerably stronger.

Every 5 May, WHO urges all health workers and leaders to maintain the profile of hand hygiene action to save patient lives. Being part of the WHO SAVE LIVES: Clean Your Hands campaign means that people can access important information to help in their practice. This year Pr Pittet and three leading surgeons explain why hand hygiene at the right times in surgical care is life saving.

Acinetobacter baumannii bacteria that are resistant to important antibiotics called carbapenems. These are highly drug resistant bacteria that can cause a range of infections for hospitalized patients, including pneumonia, wound, or blood infections.

Pseudomonas aeruginosa, which are resistant to carbapenems. These bacteria can cause skin rashes and ear infectious in healthy people but also severe blood infections and pneumonia when contracted by sick people in the hospital.

Enterobacteriaceae that are resistant to both carbepenems and another class of antibiotics, cephalosporins. This family of bacteria live in the human gut and includes bugs such as E. coli and Salmonella.

The list, which was released February 27th, 2017 and enumerates 12 bacterial threats, grouping them into three categories: critical, high, and medium.

“Antibiotic resistance is growing and we are running out of treatment options. If we leave it to market forces alone, the new antibiotics we most urgently need are not going to be developed in time,” said Dr. Marie-Paule Kieny, the WHO’s assistant director-general for health systems and innovation.

The international team of experts who drew up the new list urged researchers and pharmaceutical companies to focus their efforts on a type of bacteria known as Gram negatives.

(The terminology relates to how the bacteria respond to a stain — developed by Hans Christian Gram — used to make them easier to see under a microscope.)

Dr. Nicola Magrini, a scientist with the WHO’s department of innovation, access and use of essential medicines, said pharmaceutical companies have recently spent more efforts trying to find antibiotics for Gram positive bacteria, perhaps because they are easier and less costly to develop.

Gram negative bacteria typically live in the human gut, which means when they cause illness it can be serious bloodstream infections or urinary tract infections.

Gram positive bacteria are generally found outside the body, on the skin or in the nostrils.

Kieny said the 12 bacteria featured on the priority list were chosen based on the level of drug resistance that already exists for each, the numbers of deaths they cause, the frequency with which people become infected with them outside of hospitals, and the burden these infections place on health care systems.

Paradoxically, though, she and colleagues from the WHO could not provide an estimate of the annual number of deaths attributable to antibiotic-resistant infections. The international disease code system does not currently include a code for antibiotic-resistant infections; it is being amended to include one.

Six (6) others were listed as high priority for new antibiotics. That grouping represents bacteria that cause a large number of infections in otherwise healthy people. Included there is the bacteria that causes gonorrhea, for which there are almost no remaining effective treatments.

Three (3) other bacteria were listed as being of medium priority, because they are becoming increasingly resistant to available drugs. This group includes Streptococcus pneumoniae that is not susceptible to penicillin. This bacterium causes pneumonia, ear and sinus infections, as well as meningitis and blood infections.

The creation of the list was applauded by others working to combat the rise of antibiotic resistance.

“This priority pathogens list, developed with input from across our community, is important to steer research in the race against drug resistant infection — one of the greatest threats to modern health,” said Tim Jinks, head of drug-resistant infections for the British medical charity Wellcome Trust.

“Within a generation, without new antibiotics, deaths from drug-resistant infection could reach 10 million a year. Without new medicines to treat deadly infection, lifesaving treatments like chemotherapy and organ transplant, and routine operations like caesareans and hip replacements, will be potentially fatal.”

Restricting the use of a common antibiotic was more important than a high profile ‘deep clean’ of hospitals in massively reducing UK antibiotic resistant Clostridium difficile, a major study found.

“These findings are of international importance because other regions such as North America, where fluoroquinolone prescribing remains unrestricted, still suffer from epidemic numbers of C. diff infections.”

The study concluded that overuse of antibiotics like ciprofloxacin led to the outbreak of severe diarrhea caused by Clostridium difficile (C.diff) that hit headlines from 2006 onward. The outbreak was stopped by substantially reducing use of ciprofloxacin and related antibiotics.

Inappropriate use and widespread over prescribingof fluoroquinolone antibiotics such as ciprofloxacin in fact allowed C. diff bugs that were resistant to the drug to thrive, because non-resistant bugs in the gut were killed off by the antibiotic, leaving the way clear for rapid growth of resistant C. diff.

Concerns about hospital ‘superbugs’ which had become resistant to common antibiotics resulted in the announcement of a program of “deep cleaning” and other infection control measures in the NHS in 2007.

The study, by the University of Leeds, University of Oxford and Public Health England published today in The Lancet Infectious Diseases, found that cases of C. diff fell only when fluoroquinolone use was restricted and used in a more targeted way as one part of many efforts to control the outbreak.

The restriction of fluoroquinolones resulted in the disappearance in the vast majority of cases of the infections caused by the antibiotic-resistant C. diff, leading to around an 80% fall in the number of these infections in the UK (in Oxfordshire approximately 67% of C. diff bugs were antibiotic-resistant in September 2006, compared to only approximately 3% in February 2013).

In contrast, the smaller number of cases caused by C. diff bugs that were not resistant to fluoroquinolone antibiotics stayed the same. Incidence of these non-resistant bugs did not increase due to patients being given the antibiotic, and so were not affected when it was restricted.

At the same time, the number of bugs that were transmitted between people in hospitals did not change. This was despite the implementation of comprehensive infection prevention and control measures, like better hand-washing and hospital cleaning in this case.

The study’s authors therefore conclude that ensuring antibiotics are used appropriately is the most important way to control the C. diff superbug.

The authors note that it is important that good hand hygiene and infection control continues to be practiced to control the spread of other infections.

The study analyzed data on the numbers of C. diff infections and amounts of antibiotics used in hospitals and by GPs in the UK.

More than 4,000 C. diff bugs also underwent genetic analysis using a technique called whole genome sequencing, to work out which antibiotics each bug was resistant to.

Co-author Derrick Crook, Professor of Microbiology, University of Oxford said: “Alarming increases in UK hospital infections and fatalities caused by C. diff made headline news during the mid-2000s and led to accusations of serious failings in infection control.

“Emergency measures such as ‘deep cleaning’ and careful antibiotic prescribing were introduced and numbers of C. diff infections gradually fell by 80% but no-one was sure precisely why.

“Our study shows that the C. diff epidemic was an unintended consequence of intensive use of an antibiotic class, fluoroquinolones, and control was achieved by specifically reducing use of this antibiotic class, because only the C. diff bugs that were resistant to fluoroquinolones went away.

“Reducing the type of antibiotics like ciprofloxacin was, therefore, the best way of stopping this national epidemic of C. diff and routine, expensive deep cleaning was unnecessary. However it is important that good hand hygiene continues to be practiced to control the spread of other infections.

“These findings are of international importance because other regions such as North America, where fluoroquinolone prescribing remains unrestricted, still suffer from epidemic numbers of C. diff infections.”

Co-author Prof Mark Wilcox, Professor of Microbiology, University of Leeds, said: “Our results mean that we now understand much more about what really drove the UK epidemic of C. diff infection in the mid-2000s.

“Crucially, part of the reason why some C. diff strains cause so many infections is because they find a way to exploit modern medical practice.

“Similar C. diff bugs that affected the UK have spread around the world, and so it is plausible that targeted antibiotic control could help achieve large reductions in C. diff infections in other countries.”

The funding for the study came from the UK Clinical Research Collaboration, (Medical Research Council, Wellcome Trust, National Institute for Health Research); NIHR Oxford Biomedical Research Centre; NIHR Health Protection Research Unit in Healthcare Associated Infections and Antibiotic Resistance, University of Oxford in partnership with Leeds University and Public Health England; NIHR Health Protection Research Unit in Modelling Methodology, Imperial College London in partnership with Public Health England; and the Health Innovation Challenge Fund.

Dr. Katherine Fleming-Dutra, MD is a medical epidemiologist with the Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC). Dr. Fleming-Dutra is a Pediatrician and Pediatric Emergency Medicine physician and has focused on infectious diseases, epidemiology, and antibiotic stewardship in the outpatient setting in her career at the CDC.

Dr. Fleming-Dutra spent an hour with us discussing the Over Prescribing Of Antibiotics — and the Key to Fighting Antibiotic-Resistance — clinicians and patients.

The guidelines, programs, campaigns, tracking methods, and tools being provided by the CDC are outstanding and need to be shared and implemented by clinicians to continue reducing the rate by 50% by 2020 of all inappropriate selections and incorrect duration in antibiotic therapies. Antibiotic Stewardship programs are available and should be in place across the healthcare industry.

We know that the CDC’s most recent figure for C. difficile-associated deaths in the U.S. is considerably higher than that of any previous survey. According to the CDC*

Nearly 500,000 patients are diagnosed with a C. diff infection estimated per year in the U.S., with more than 29,000 deaths

Up to $4.8 billion in excess health care costs for acute care facilities

Prevention steps include antibiotic stewardship and improved infection control in hospitals, doctor’s offices, nursing homes and other healthcare facilities

“C. diff. Spores and More ™“ spotlights world renowned topic experts, research scientists, healthcare professionals, organization representatives, C. diff. survivors, board members, and their volunteers who are all creating positive changes in the
C. diff. community and worldwide.

Through interviews – each episode becomes part of the living library. The podcasts are accessed continuously promoting education and advocating the C Diff Foundation’s mission that are connecting, educating, and empowering listeners worldwide.

Questions received through the show page portal will be reviewed and addressed by the show’s Medical Correspondent, Dr. Fred Zar, MD, FACP, Dr. Fred Zar is a Professor of Clinical Medicine, Vice Head for Education in the Department of Medicine, and Program Director of the Internal Medicine Residency at the University of Illinois at Chicago. Over the last two decades he has been a pioneer in the study of the treatment of Clostridium difficile disease and the need to stratify patients by disease severity.

A Nevada woman has died from an infection resistant to all available antibiotics in the United States, public health officials report.

According to the Centers for Disease Control and Prevention, the woman’s condition was deemed incurable after being tested against 26 different antibiotics.

Though this isn’t the first case of pan-resistant bacteria in the U.S., at this time it is still uncommon. Still, experts note that antibiotic resistance is a growing health concern globally and call the newly reported case “a wake up call.”

“This is the latest reminder that yes, antibiotic resistance is real,” Dr. James Johnson, a professor specializing in infectious diseases at the University of Minnesota Medical School, told CBS News. “This is not some future, fantasized armageddon threat that maybe will happen after our lifetime. This is now, it’s real, and it’s here.”

According to the report, the woman from Washoe County was in her 70s and had recently returned to America after an extended trip to India. She had been hospitalized there several times before being admitted to an acute care hospital in Nevada in mid-August.

Doctors discovered the woman was infected with carbapenem-resistant Enterobacteriaceae(CRE), which is a family of germs that CDC director Dr. Tom Frieden has called “nightmare bacteria” due to the danger it poses for spreading antibiotic resistance.

The woman had a specific type of CRE, called Klebsiella pneumoniae, which can lead to a number of illnesses, including pneumonia, blood stream infections, and meningitis. In early September, she developed septic shock and died.

The authors of the report say the case highlights the need for doctors and hospitals to ask incoming patients about recent travel and if they have been hospitalized elsewhere.

Other experts say it underscores the need for the medical community, the government and the public to take antibiotic resistance more seriously.

According to the CDC, at least two million people become infected with antibiotic resistant bacteria each year, and at least 23,000 die as a direct result of these infections.

The World Health Organization calls antibiotic resistance “one of the biggest threats to global health.”

A grim report released last year suggests that if bacteria keep evolving at the current rate, by 2050, superbugs will kill 10 million people a year.

While scientists are working to develop new antibiotics, that takes time, and experts encourage doctors and the public to focus on prevention efforts.

One of the most important ways to prevent antibiotic resistance is to only take antibiotics only when they’re necessary.

“Drug resistance like this [case] generally develops from too much exposure to antibiotics,” assistant professor of pediatrics at Johns Hopkins University School of Medicine and director of the Pediatric Antimicrobial Stewardship Program at The Johns Hopkins Hospital, told CBS News. “Every time you’re placed on an antibiotic it’s important to question if it’s absolutely necessary and what’s the shortest amount of time you can take this antibiotic for it to still be effective.”

Johnson notes that medical tourism – the practice of traveling to another country to obtain medical treatment, typically at lower cost – may no longer be worth the risk. “With this [antibiotic] resistance issue, the risk/benefit of this approach really changes and I think that people really need to be aware and seriously consider if it’s a good idea given the possibility of this kind of thing,” he said.

Frequent hand washing, particularly in healthcare settings, is also extremely important in preventing the spread of germs.

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